AJDRAJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 2009;30:831.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1444

INTERVENTIONAL

Comparison of 2D Digital Subtraction Angiography and 3D Rotational Angiography in the Evaluation of Dome-to-Neck Ratio

W. Brinjikji, H. Cloft, G. Lanzino and D.F. Kallmes

From the Mayo Medical School (W.B.), Mayo Clinic, Rochester, Minn; and Departments of Radiology (H.C., D.F.K.) and Neurosurgery (G.L.), Mayo Clinic, Rochester, Minn.

Please address correspondence to David F. Kallmes, MD, Mayo Clinic, OL 1–115, 200 SW First St, Rochester, MN 55905; e-mail: kallmes.david{at}mayo.edu

BACKGROUND AND PURPOSE: Dome-to-neck ratio of intracranial aneurysms is an important predictor of outcomes of endovascular coiling. 3D imaging techniques are increasingly used in evaluating the dome-to-neck ratio of aneurysms for intervention. The purpose of this study was to determine whether 3D rotational angiography (3DRA) can be used to determine accurately the dome-to-neck ratio of intracranial aneurysms when compared with conventional 2D digital subtraction angiography (2D DSA).

MATERIALS AND METHODS: A retrospective analysis of 180 patients with 205 intracranial aneurysms who underwent both 2D DSA and 3DRA for evaluation of previously untreated aneurysms was conducted. Dome-to-neck ratios were compared between 2D DSA and 3DRA images. The mean difference in dome-to-neck ratios between 2D DSA and 3DRA was calculated. The proportions of "wide-neck" aneurysms seen on 2D DSA and 3DRA were compared by using 2 different definitions of "wide-neck," including <1.5 and <2.0.

RESULTS: The average dome-to-neck ratio was 1.81 ± 0.55 and 1.55 ± 0.48 for 2D DSA and 3DRA, respectively (P < .0001). When we defined "wide-neck" as a dome-to-neck ratio <1.5, sixty-nine (33.7%) aneurysms were wide-neck on 2D DSA compared with 119 (58%) on 3DRA (P < .0001). When we defined "wide-neck" as dome-to-neck ratio <2.0, one hundred forty-two (69.3%) aneurysms were wide-neck on 2D DSA compared with 173 (84.4%) on 3DRA (P = .0004).

CONCLUSIONS: In this retrospective study, 3DRA measurements resulted in significantly lower dome-to-neck ratios and significantly larger proportions of aneurysms defined as "wide-neck" compared with 2D DSA. Scrutiny of 2D DSA may offer substantial benefit over 3D techniques when triaging patients to or from endovascular therapy.




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W. Brinjikji, H.J Cloft, and D.F. Kallmes
Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?
AJNR Am. J. Neuroradiol., September 1, 2009; 30(8): 1513 - 1517.
[Abstract] [Full Text] [PDF]


Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X